Maternal Education Level Predicts Cognitive, Language, and Motor Outcome in Preterm Infants in the Second Year of Life

Abstract

Objective To evaluate the relative impact of maternal education level (MEL) on cognitive, language, and motor outcomes at 20 months' corrected age (CA) in preterm infants.

Study Design A total of 177 preterm infants born between 2008 and 2010 were tested at 20 months' CA using the Bayley Scales of Infant and Toddler Development-III. Multiple regression analyses were done to determine the relative impact of MEL on cognitive, language, and motor scores.

Results Infants born to mothers with high school MEL were 3.74 times more likely to have a subnormal motor index, while those born to mothers with some college and graduate school MEL had reduced odds (0.36 and 0.12, respectively) of having subnormal language index at 20 months. In linear regression, MEL was the strongest predictor of cognitive, language, and motor scores, and graduate school MEL was associated with increases in cognitive, motor, and language scores of 8.49, 8.23, and 15.74 points, respectively.

Conclusions MEL is the most significant predictor of cognitive, language, and motor outcome at 20 months' CA in preterm infants. Further research is needed to evaluate if targeted interventions that focus on early childhood learning and parenting practices can ameliorate the impact of low MEL.

Keywords

maternal education - neurodevelopmental outcomes - prematurity - motor outcome

• References

• 1 Ko G, Shah P, Lee SK, Asztalos E. Impact of maternal education on cognitive and language scores at 18 to 24 months among extremely preterm neonates. Am J Perinatol 2013; 30 (9) 723-730
• 2 Voss W, Jungmann T, Wachtendorf M, Neubauer AP. Long-term cognitive outcomes of extremely low-birth-weight infants: the influence of the maternal educational background. Acta Paediatr 2012; 101 (6) 569-573
• 3 Wang LW, Wang ST, Huang CC. Preterm infants of educated mothers have better outcome. Acta Paediatr 2008; 97 (5) 568-573
• 4 Weisglas-Kuperus N, Hille ET, Duivenvoorden HJ , et al; Dutch POPS-19 Collaborative Study Group. Intelligence of very preterm or very low birthweight infants in young adulthood. Arch Dis Child Fetal Neonatal Ed 2009; 94 (3) F196-F200
• 5 Rodrigues MC, Mello RR, Silva KS, Carvalho ML. Risk factors for cognitive impairment in school-age children born preterm: application of a hierarchical model. Arq Neuropsiquiatr 2012; 70 (8) 583-589
• 6 Wilson-Costello D, Friedman H, Minich N , et al. Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002. Pediatrics 2007; 119 (1) 37-45
• 7 Robertson CM, Watt MJ, Dinu IA. Outcomes for the extremely premature infant: what is new? And where are we going?. Pediatr Neurol 2009; 40 (3) 189-196
• 8 Horbar JD, Carpenter JH, Badger GJ , et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012; 129 (6) 1019-1026
• 9 Vohr BR, Poindexter BB, Dusick AM , et al; National Institute of Child Health and Human Development National Research Network. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics 2007; 120 (4) e953-e959
• 10 Vohr BR, Poindexter BB, Dusick AM , et al; NICHD Neonatal Research Network. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics 2006; 118 (1) e115-e123
• 11 Johnson S, Evans TA, Draper ES , et al. Neurodevelopmental outcomes following late and moderate prematurity: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2015; 100 (4) F301-F308
• 12 Beaino G, Khoshnood B, Kaminski M , et al; EPIPAGE Study Group. Predictors of the risk of cognitive deficiency in very preterm infants: the EPIPAGE prospective cohort. Acta Paediatr 2011; 100 (3) 370-378
• 13 Hollingshead A. Four factor index of social status. Yale J Sociol 2011; 8: 21-53
• 14 Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003; 3: 13
• 15 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (1) 1-7
• 16 Amiel-Tison C, Stewart A. Follow up studies during the first five years of life: a pervasive assessment of neurological function. Arch Dis Child 1989; 64 (4 Spec No) 496-502
• 17 Bayley N. Bayley Scales of Infant Development. 3rd ed. San Antonio, TX: The Psychological Corporation; 2006
• 18 Vohr BR, Wright LL, Dusick AM , et al; Neonatal Research Network. Center differences and outcomes of extremely low birth weight infants. Pediatrics 2004; 113 (4) 781-789
• 19 Wong HS, Edwards P. Nature or nurture: a systematic review of the effect of socio-economic status on the developmental and cognitive outcomes of children born preterm. Matern Child Health J 2013; 17 (9) 1689-1700
• 20 Stiver ML, Kamino D, Guo T , et al. Maternal postsecondary education associated with improved cerebellar growth after preterm birth. J Child Neurol 2015; 30 (12) 1633-1639
• 21 Lowe JR, Erickson SJ, Maclean P, Schrader R, Fuller J. Association of maternal scaffolding to maternal education and cognition in toddlers born preterm and full term. Acta Paediatr 2013; 102 (1) 72-77